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Ha, Kim, Gwak, and Jang: Fracture and Dislocation of Lisfranc Joint: Treatment with Screw and Kirschner Wire
Original Article

J Korean Foot Ankle Soc 2015;19(4):181-187.

Published online: 10 January 2015

DOI: https://doi.org/10.14193/jkfas.2015.19.4.181

Fracture and Dislocation of Lisfranc Joint: Treatment with Screw and Kirschner Wire

Dong-Jun Ha*, Jeon-Gyo Kim†, Heui-Chul Gwak, Yue-Chan Jang*

Department of Orthopedic Surgery, Busan Paik Hospital, Inje University School of Medicine, Busan, Korea

*Department of Orthopedic Surgery, Maryknoll Hospital, Busan, Korea

†Department of Orthopedic Surgery, District Hospital, Korea Army Training Center, Nonsan, Korea

Corresponding Author: Heui-Chul Gwak Department of Orthopedic Surgery, Inje University Busan Paik Hospital, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea Tel: 82-51-890-6129, Fax: 82-51-892-6619, E-mail: ortho1@hanmail.net

Received 8 April 2015       Revised 19 October 2015       Accepted 27 October 2015

Copyright © 2015 Korean Foot and Ankle Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to retrospectively analyze the clinical results of screws and Kirschner wire (K-wire) fixation in patients with fracture dislocation of Lisfranc joint and the consequence of screw breakage.

Materials and Methods

Sixty patients underwent Lisfranc joint open reduction and removal of internal fixators from January 2007 to December 2011. Forty-nine cases (81.7%) underwent operations with screw alone, and 11 cases (18.3%) underwent operations with both screws and K-wires. Type of internal fixators, duration of internal fixator removal, breakage of internal fixators and satisfaction with reduction were investigated. Additionally, American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scales were analyzed.

Results

The internal fixator was broken in 5 cases (8.3%). The average duration of instrument removal was 154 days in the non-broken screw group and 268.6 days in the broken screw group (p<0.05). The average AOFAS midfoot scale was 77.4 in the non-broken screw group and 74.2 in the broken screw group. The most commonly damaged portion was the first tarsometatarsal (Lisfranc) joint.

Conclusion

Treatment with screws and K-wires was effective in patients with fracture dislocation of Lisfranc joint. The appropriate time for screw removal should be considered.

Keywords: Tarsal joint, Lisfranc joint, Bone screw, Kirschner wire, Breakage

References

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Figure 1.
Broken screw case. (A) Preoperative anteroposterior (AP) weightbearing radiograph is shown for a patient with fracture dislocation of Lisfranc joint. (B) Postoperative AP radiograph shows well reduced Lisfranc joint with two screws. (C) AP radiograph shows broken screw. (D) Postoperative AP radiograph shows broken screw remnant in middle cuneiform bone.
jkfas-19-181f1.tif
Figure 2.
Non-broken screw case. (A) Preoperative anteroposterior (AP) nonweightbearing radiograph is shown for a patient with fracture dislocation of Lisfranc joint. Lateral partial incongruity of second tarsometatarsal joint was noted. (B) Postoperative AP radiograph shows well reduced Lisfranc joint with multiple screws. (C) All screws are removed. Lisfranc joint shows good congruity.
jkfas-19-181f2.tif
Table 1.
Patients, Injury, and Treatment Characteristics
Patient No. Sex Age (yr) Injury mechanism Myerson's classification BMI (kg/m2) HWR period (day) Fixation method Screw breakage
1 F 40 MVA A 22 110 Screw N
2 M 24 Crush B2 25 186 Screw+K-wire N
3 M 47 MVA B1 23 453 Screw Y
4 M 64 Inversion B2 22 190 Screw N
5 F 74 Inversion B1 22 120 Screw N
6 M 48 Inversion A 24 132 Screw+K-wire N
7 M 19 Crush B2 23 105 Screw N
8 F 33 Crush B1 25 100 Screw N
9 M 16 MVA A 24 115 Screw+K-wire N
10 M 26 Crush B2 24 221 Screw Y
11 M 49 MVA B2 23 230 Screw+K-wire Y
12 F 52 Inversion B2 23 145 Screw N
13 F 50 Fall C1 24 222 Screw+K-wire N
14 F 30 MVA B1 24 111 Screw+K-wire N
15 M 47 MVA B2 23 275 Screw+K-wire N
16 M 56 MVA C1 24 324 Screw N
17 M 74 MVA C1 23 189 Screw+K-wire Y
18 F 54 Inversion B1 25 250 Screw Y
19 M 37 Fall B2 26 205 Screw N
20 F 76 MVA B2 24 110 Screw N
21 F 22 MVA C1 23 134 Screw N
22 M 63 MVA B2 22 155 Screw N
23 M 39 MVA B2 26 105 Screw N
24 M 57 MVA B1 22 155 Screw+K-wire N
25 F 59 MVA B2 24 137 Screw N
26 M 35 MVA B2 23 152 Screw N
27 M 15 MVA B2 25 134 Screw N
28 M 46 Fall B1 22 206 Screw N
29 M 49 Inversion A 23 155 Screw+K-wire N
30 M 40 MVA B1 23 147 Screw N
31 F 34 Fall B2 25 106 Screw N
32 M 64 Inversion B1 24 119 Screw N
33 F 35 Fall C2 22 212 Screw N
34 M 30 Fall B2 22 109 Screw N
35 M 24 Fall C1 24 128 Screw N
36 M 45 MVA B2 22 111 Screw N
37 M 50 Fall B1 24 122 Screw N
38 F 76 Inversion B2 24 159 Screw N
39 M 22 Fall B1 25 111 Screw N
40 M 34 MVA C1 25 125 Screw N
41 M 45 MVA B1 22 178 Screw N
42 M 14 MVA B2 25 132 Screw N
43 M 34 MVA B1 24 124 Screw N
44 M 58 MVA A 24 124 Screw N
45 M 21 Crush B2 23 125 Screw N
46 F 54 Fall B2 24 119 Screw N
47 M 57 MVA A 24 135 Screw N
48 M 20 Inversion B2 23 167 Screw N
49 M 67 MVA C2 22 120 Screw N
50 M 59 Inversion C1 22 131 Screw N
51 M 18 Fall B1 24 134 Screw N
52 M 53 MVA B2 23 124 Screw N
53 F 68 MVA B2 24 119 Screw N
54 M 44 Fall C2 22 156 Screw N
55 M 44 MVA A 25 127 Screw N
56 M 36 MVA B2 24 121 Screw N
57 M 18 MVA B1 23 131 Screw N
58 F 24 Fall B2 24 125 Screw+K-wire N
59 M 44 Fall B1 23 145 Screw N
60 M 34 MVA B2 24 147 Screw N

M: male, F: female, MVA: motor vehicle accident, BMI: body mass index, HWR: hardware removal, K-wire: Kirschner wire, Y: yes, N: no.

Table 2.
Details of Breakage Case
Patient No. Sex Age (yr) HWR period (day) Screw Screw+K-wire Broken part AOFAS midfoot scale
1 M 47 453 Y N 1st TMT 72
2 M 26 221 Y N 1st TMT 76
3 M 49 230 N Y 1st TMT, cuboid, 2nd MT 81
4 M 74 189 N Y 1st TMT 69
5 F 54 250 Y N 1st TMT 73

M: male, F: female, HWR: hardware removal, Y: yes, N: no, K-wire: Kirschner wire, TMT: tarsometatarsal joint, MT: metatarsal bone, AOFAS: American Orthopaedic Foot and Ankle Society.

Table 3.
Comparison of Parameters in Both Groups
Parameter Group I Group II p-value
Age (yr) 50.0 (26∼74) 42.1 (14∼76) 0.74
Sex (male:female) 4:1 40:15 0.55
BMI (kg/m2) 23.6 (23∼25) 23.9 (22∼26) 0.57
AOFAS midfoot scale 74.2 (69∼81) 77.4 (46∼94) 0.82
HWR period (day) 268.6 (189∼453) 143.9 (100∼324) 0.02*

Values are presented as mean (range) or ratio.

Group I: broken screw or Kirschner wire (K-wire) group after Lisfranc injury operation, Group II: non-broken screw or K-wire group after Lisfranc injury operation.

BMI: body mass index, AOFAS: American Orthopaedic Foot and Ankle Society, HWR: hardware removal.

* Statistical analysis was done by Mann-Whitney U-test.

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